Empirical evidence for symbiotic medical education: A comparative analysis of community and tertiary-based programs

Flinders University Rural Clinical School, Flinders University, Adelaide, South Australia, Australia.
Medical Education (Impact Factor: 3.2). 03/2006; 40(2):109-16. DOI: 10.1111/j.1365-2929.2005.02366.x
Source: PubMed


Flinders University has developed the Parallel Rural Community Curriculum (PRCC), a full year clinical curriculum based in rural general practice in South Australia. The examination performance of students on this course has been shown to be higher than that of their tertiary hospital-based peers.
To compare the learning experiences of students in the community-based programme with those of students in the tertiary hospital in order to explain these improved academic outcomes.
A case study was undertaken, using an interpretivist perspective, with 3 structured interviews carried out over 2 academic years with each of 6 students from the community-based programme and 16 students from the tertiary hospital. The taped interviews were transcribed and analysed thematically using NUD*IST software.
The community-based programme was successful in immersing the students in the clinical environment in a meaningful way. Four key themes were found in the data. These represented clear differences between the experiences of the community-based and hospital-based students. These differences involved: the value that students perceived they were given by supervising doctors and their patients; the extent to which the student's presence realised a synergy between the work of the university and the health service; opportunities for students to meet the aspirations of both the community and government policy, and opportunities for students to learn how professional expectations can mesh with their own personal values.
This study has provided empirical evidence for the importance of the concept of symbiosis in understanding quality in medical education.

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    • "While longitudinal clerkship students work with several interprofessional hospital and community teams, it is the family practice team in which the student is based that is significant for learner development. Regan-Smith et al. [7] described how to explicitly integrate the learner into an ambulatory care clinic by conceptualising the practice as a ‘microsystem’, and others have shown that extended placement in this teaching microsystem can help students appreciate its importance in the health-care environment [8]. A microsystem has been defined as…a small group of interdependent people in health care delivery who work together on a regular basis, to provide care to a discrete population of patients[9], and importantly includes the patient. "
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    • "A recent survey of sixteen medical schools from four countries revealed that the sub-group of 2, 700 students who had completed longitudinal integrated clerkships were very supportive of the program, and performed as well as colleagues from more traditional clerkships in national exams [14]. Other student outcomes reported from national and international long-term placements have included continuity of patient care experiences; continuity of supervision and curriculum; advocacy for the patient and health service; participatory learning; mentoring; team work; and confident and skilled students [4,15,16]. "
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